Despite repeated calls for a digital healthcare records system, paper usually runs the show. You fill out the insurance form multiple times. Your critical records might be at another location across town. If you experience a health crisis, emergency room doctors might lack access to anything about your history. Deb Bass wants to eliminate such situations. Bass spent 20 years in nursing before co-founding Bass and Associates in 1993. Her company specializes in IT consulting for the healthcare field. In 2005, the Nebraska Health Information Initiative (NeHII) hired Bass and Associates to implement a cloud-based health information exchange system across Nebraska. Four years later, her company ran a pilot program for NeHII at Children’s Hospital, Nebraska Medical Center, Alegent Health and Blue Cross Blue Shield for 90 days before taking the program statewide. The exchange is designed to share patient data across multiple computer systems in physician offices and health care facilities. Using a broadband connection, doctors can access patient information that often includes lab and radiology records, medications, allergies, and basic demographic information. Physicians pay between $32 and $52 per month for access, and the system is also funded from stimulus dollars received from the American Recovery and Reinvestment Act of 2009. That stimulus funding will run out eventually and NeHII wants to be self-sustaining within four years. Licensing fees will grow as more providers take part, Bass says, and other revenue-generating ideas are being considered. “We will offer a clearinghouse for electronic healthcare claims, and NeHII gets a small portion of every transaction,” Bass says. “We are providing consulting to other states, and are exploring offering our framework to smaller health information exchanges. There are several other entrepreneurial business ideas we are working on.” Bass says some physicians haven’t signed on because of the lack of broadband availability in rural parts of the state. In addition to needing broadband access, healthcare providers must have a backup broadband connection, Bass says. For areas with limited Internet services, this has proven problematic. Some physicians haven’t signed on because they’re skeptical concerning computerized records and privacy. Bass said NeHII only allows physicians and health care providers authorized to prescribe medications to access the system. Audit trails track whenever a patient’s record is accessed and who is accessing the information. There are several benefits to electronic records access. Diagnosis and treatment are less dependent on the memory of past caregivers. According to Bass, the number of unnecessary or redundant tests can be reduced because existing records can be seen. “They don’t have to wait,” Bass says. “In the past, it could be weeks to get partial information, and sometimes they never got complete records.” Doctors can further use the system to track patient trends which may not have been easily identified in a paper-based chart system. Bass hopes physicians will use NeHII much like financial analysts use cloud-based financial software to predict economic activity. “Because we haven’t been able to capture the data, it’s been difficult to know what is working in healthcare,” Bass says. “We’ll now be able to aggregate and analyze it. For example, a physician can look at his patients and their demographics, and can explore treatment programs based on treatments provided to others who resemble his patients.” For patients, a system like NeHII can mean not having to register for every clinic on an exam day. For example, in a paper-based world, patients fill out redundant paperwork if they have an exam in one clinic and an appointment at a doctor’s office in another location. This would not be the case for hospitals using systems similar to NeHII’s. “Once we get this electronic system … you won’t be handed a pencil and clipboard,” Bass says. He said records for 1.6 million people are in the NeHII system, representing about 60 percent of the population of Nebraska. In March 2009, NeHII set a goal of having 80 percent of hospital beds statewide represented in its system within three years. Halfway through those three years, Bass says NeHll is on track. “We now have 40 percent of the beds in the state, and we want 80 percent by March 2012,” Bass says. “We are being asked to speak around the country, and we are helping neighboring states, but our number one goal is to build statewide in Nebraska.” Charting The Future To become part of NeHII most healthcare systems in the state must convert their records into an electronic format. Methodist Health System in Omaha completed its Electronic Medical Records system in September, using PowerChart from Cerner Corporation in Kansas City. It took 18 months, according to Methodist Chief Information Officer Roger Hertz, and the system is live at three Methodist hospitals and 23 other locations. Computers were placed in every examination room. Health care providers use them to capture patient information such as basic demographics, chief complaint, medications, allergies and medical and social history. Methodist’s new system electronically faxes prescriptions to pharmacies, but Hertz says online electronic transmission of prescriptions should begin soon. “There are a lot of other functions that are not in the system yet,” Hertz says. “We want to get the number of clicks down to just a few, for example. The next phase is going to be voice recognition software, so the physician doesn’t have to type in the information.” During implementation, trainers worked onsite to prepare Methodist’s physicians, and created instructional videos. “That really helped a lot,” Hertz says. “Most physicians were in favor of it. A few were skeptical. Once they were trained, they were all very supportive.” Besides a desire to be part of NeHII, other factors are pushing development of electronic records in the healthcare field. “There is a federal stimulus program that gives you incentives to accelerate the use and adoption,” Hertz says. “That is really pushing things. Everybody is trying to do this right now.” — Steve Brewer

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